Chemotherapy - Week 10: Preparing for surgery

With the fantastic news that my mum was to have surgery, a whole raft of appointments came flooding in and I realised there was so much preparation to do in advance.  First off was an appointment with the consultant to discuss the surgery.  It can be very daunting so I would strongly recommend you take a close friend or relative for support.  My mum's surgeon is a lovely man who is extremely patient and answered all the questions we had in a simplistic way.  The Oncology Nurse who has been with my mother every step of the way was also in the appointment to make the whole experience less frightening.  My mum and I had discussed the appointment prior to our arrival so we had a list of questions prepared which was really helpful as we didn't want to walk out and remember a question 10 mins later.  Here's an (extensive) list of the things we asked and I think, demonstrates our practical nature:

1. What is being removed?
2. How long will the surgery take?
3. What medication should be stopped prior to surgery?
4. How much of the cancer will remain after surgery?  What is the aim of the surgery?
5. What are the complications of the surgery?
6. How long will recovery take?  What is the approximate length of stay in hospital?
7. Will the surgery be at this hospital?  What time should we arrive?
8. How will my pain be managed?
9. Who will be doing the surgery?
10. What preparation is required pre-surgery?
11. How will surgery affect my prognosis?

We were surprised to discover that the surgery would be dependant on a pre-op assessment and due to the scale of the surgery, an assessment of her physical ability to withstand such an extensive operation called Ultra Radical Debulking Surgery.  The aim of the surgery as the consultant told us, was to remove all visible signs of cancer.  Essentially cancer-free with the removal of the following:

• omentum - a large apron-like fold of visceral peritoneum that hangs down from the stomach 
• peritoneum - the serous membrane that forms the lining of the abdominal cavity 
• liver - the liver is located in the upper right quadrant of the abdomen, below the diaphragm.  The liver has a wide range of functions, including detoxification of various metabolites, protein synthesis, and the production of biochemicals necessary for digestion.  It also plays a role in metabolism, regulation of glycogen storage, decomposition of red blood cells and hormone production
• restructure of the bowel - the bowel is the lower part of the digestive system.  The digestive system processes all the food we eat and breaks it down into nutrients for the body. It also gets rid of any solid waste matter from the body as poo.  It didn't surprise me that this was on the list as she had been saying since the start of her diagnosis that she felt she was never completely emptying her bowels.  The bowel is divided into the small bowel (or small intestine) and the large bowel (or colon and rectum). The small bowel is where you digest and absorb the nutrients from the food you eat. The large bowel absorbs water from the digested food and forms poo
• full hysterectomy - ovaries, fallopian tubes, womb
• appendix

 

This was the point at which I stopped the Surgeon and said simply "That's a lot.  A lot."  The surgeon confirmed that this was a major surgery and would be tantamount to running a marathon for her (I later discovered for him aswell).  He was also very clear that he could not be certain until during the surgery as to what was going to be removed, as the first part of the surgery would involve a Laparoscopy.  A Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis using a laparoscope, without having to make large incisions in the skin.  The laparoscope is a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a television monitor.   He would only know, once he was in there as to whether the surgery was likely to be 100% successful, and if not, he would likely not proceed.  This news filled me with dread and fear but in hindsight, I am grateful to him for not getting my hopes up too much and for providing a sense of realism.  The uncertainty was very scary to have to live with but we knew that this would be her only chance given her mixed response to chemotherapy and that this was amazing progress since my mother was told at diagnosis that surgery would not be an option given the spread of the disease at that point.  It was expected to be a long surgery of between 6 - 10 hours with a recovery period of 10 - 14 days and risk of complications such as bleeding; infection; stroke; heart attack and death.  Let me tell you as carer, it's very hard to have to tell someone this but as a daughter, it's even more difficult.

There was a lot of information and I'm glad that I remembered to take my notebook and pen to jot the major points down.  It was also a meeting that brought lots of mixed emotions.  Ecstatic to have the opportunity to have surgery and finally, remove the cancer but so scared at the gravity of the surgery and trepidations as we did not want to get our hopes up until the pre-op assessment had been passed. We were anxious for the pre-op assessment as prior to diagnosis, my mum had been really active walking up to 2 miles per day.  But due to the rapid spread of her cancer, my mother now walks with a walking stick due to Lymphdema and can be unsteady on her feet due to the ascites.  Furthermore, my mother has high blood pressure which was managed well through medication before diagnosis but would at times spike during chemotherapy.  To be honest, there have been so many twists and turns on this cancer journey with my mother, such heartbreaking news followed by rapid response to treatment, that we doubt and do not want to get our hopes up until there is some certainty.  And so began a really difficult week of extreme uncertainty.  It was unfortunate that the pre-op assessment also could not be completed in one day.  Instead it was broken up into several stages and several different appointments.  It's a good job that I only work part-time else I would not have been at work at all that week!  Preparation for surgery consisted of:

1. A thorough interview of the full medical history and information to be provided on how to prepare for the surgery such as time for arrival and dietary changes prior to surgery 
2. An ECG - this consists of lying on a bed whilst the nurse puts sticky plasters on the chest and records the rhythm of the heart culminating in a print out.
3. Blood tests.  Blood needs to be taken so that the red blood cells can be measured
4. A meeting with the stoma nurse to understand the implications of the stoma.  In preparation for the surgery, the stoma nurse also marked two sites on my mother's abdomen where the stoma would be placed should there be a requirement on either the large colon or the small colon
5. An appointment with the anaesthetist to discuss the surgery, pain management and discuss how her heart is likely to respond during and after surgery to aid the success of the surgery and recuperation
6. Cardio-Pulomonary Exercise Test (CPET) is a non-invasive method used to assess the performance of the heart and lungs at rest and during exercise for patients due to undergo a major surgery.  We were told that the CPET would entail  a short period on an upright bicycle whilst breathing through a mouthpiece. Each breath is measured to assess how the body is performing. The capacity and strength of the lungs is measured before and during exercise. The heart tracing (ECG) will also be recorded prior to, during and post exercise.  My mum was quite worried about this test as since diagnosis she had done little exercise and again was hindered by ascites - the accumulation of fluid in the abdomen.  In fact, the CPET is not a maximum tolerance test but an exercise to inform the anaesthetist as to how a patients heart and lungs will perform under surgical conditions.  The only advice I would give is:

• Wear comfortable clothing and shoes such as trainers
• Don't eat a heavy meal 2 hours before the appointment
• Don't take vigorous exercise 30 mins beforehand

In our case, the various appointments took us right up to the surgery date and in the end, we didn't get final confirmation that the surgery was definitely due to go ahead until 6pm the previous evening. 6pm!  This did though, make the time go very quickly and before we knew it, the surgery was upon us!

I'm going to dedicate the next blogpost to the surgery itself in full detail as it deserves it.  So many emotions and so many things that happened.  My mum's experience gave me a new found respect for surgeons and the NHS and I want to dedicate the next blog post to the people that saved my mother's life and in turn, mine too.